Comparison of lymphatic complications between sentinel node navigation surgery and pelvic lymphadenectomy in patients with cervical cancer

Background Sentinel node navigation surgery (SNNS) has been frequently used in early cervical cancer. However, the incidence and potential reduction of lymphatic complications following the removal of the sentinel lymph node remain unknown. Thus, this study aimed to evaluate the occurrence of lymphatic complications post sentinel node navigation surgery in patients with early cervical cancer. Methods A total of 167 patients, including 70 and 97 patients who had undergone SNNS and pelvic lymphadenectomy (PLA), respectively, were enrolled in this study. We compared the lymphatic complications (lower extremity lymphedema and pelvic lymphocele) between the SNNS and PLA groups. Results The median number of sentinel lymph nodes removed was 2 (range: 1–14). Among the 70 patients in the SNNS group, there were 0 (0%) and 3 (4.3%) occurrences of lower extremity lymphedema and pelvic lymphocele, respectively. The occurrences of lower extremity lymphedema and pelvic lymphocele were significantly lower in the SNNS group than in the PLA group, despite circumflex iliac node removal. Conclusions The occurrence of lymphatic complications (lower extremity lymphedema and pelvic lymphocele) was significantly lower in the SNNS group than in the PLA group. We found that SNNS, and not PLA, was the best treatment option for preventing the development of lower extremity lymphedema and pelvic lymphocele, despite circumflex iliac node preservation.

Distribution Pattern of Circumflex Iliac Node Distal to the External Iliac Node Metastasis in Stage IA to IIA Cervical Carcinoma

ObjectivesThis study aimed to investigate the metastatic rate of circumflex iliac node distal to the external iliac node (CINDEIN) and its associations with clinicopathological factors in patients with stage IA to IIA cervical cancer to determine whether dissection of CINDEIN had a role in surgery of these patients.MethodsSix hundred thirty-three patients with the International Federation of Gynecology and Obstetrics stage IA to IIA cervical cancer who underwent radical hysterectomy and pelvic lymphadenectomy were retrospectively reviewed. The metastatic rate and distribution of the pelvic lymph nodes (PLNs) and CINDEINs were analyzed.ResultsThe PLN metastatic rate was 25.6% (162 of 633 patients). Sixteen of 162 node-positive patients had CINDEIN metastases. Only 1 patient without PLN metastases had positive CINDEIN nodes. Univariate analysis revealed that other PLNs (including lymph nodes collected from obturator, external iliac, and internal iliac regions) and lymph vascular space involvement were the risk factors of CINDEIN metastases (P < 0.05). Other PLN metastasis (odds ratio, 50.6; 95% confidence interval, 6.6–386.7) was an independent risk factor for metastasis to CINDEIN by binary logistic regression analysis.ConclusionsCircumflex iliac node distal to the external iliac node metastases seemed to occur secondarily to widespread PLN metastases. In early stage cervical cancer, removal of the CINDEIN as a routine surgical procedure might be omitted to reduce operation time and minimize surgical morbidity.

Prognosis and recurrence pattern of patients with cervical carcinoma and pelvic lymph node metastasis

Aim: To investigate the prognostic risk factor(s) and pattern of disease relapse of patients with cervicalcarcinoma and pelvic node metastasis.Methods: One hundred twenty four cases of FIGOIB1~IIA cervical carcinoma with pelvic node metastasistreated from January 1991 to December 2001 were selected for this study. Prognosis and recurrence wereretrospectively analyzed using the clinico-pathological data.Results: The overall 5 year survival and disease-free survival (DFS) was 63.3% and 61.4% respectively.Overall recurrence rate was 39.5% (49/124). Intra-pelvic relapse (25/41, 61.0%) was significantly morefrequent than extra-pelvic relapse (13/41, 1.7%, P=0.008). Multivariate analysis identified involvement ofcommon iliac node as independent prognostic factor (P=0.035). According to this factor, node-positivepatients could be divided into low risk group (without common iliac node involvement, 104 cases) and highrisk group (with common iliac node involvement, 20 cases). The DFS were 69.4% and 24.5% respectively,and the difference was significant (P=0.003). Intra-pelvic relapse was observed in 22.1% of low risk and25.0% of high risk group respectively, the difference was not significant (P>0.05), however extra-pelvicrelapse was seen in 7.7% of low risk and 40.0% of high risk group, and the difference was significant(P<0.001).Conclusions: Common iliac node involvement is the significant factor that influences the prognosis ofpatients with cervical carcinoma and pelvic node metastasis. According to this factor, survival and recurrencepattern differs significantly. These findings provide important reference for individualized modification andinvestigation of treatment mode.Keywords: Cervical neoplasms; lymph node metastasis; prognosisDOI: 10.3126/njog.v4i1.3327Nepal Journal of Obstetrics and Gynaecology June-July 2009; 4(1): 19-24